NGS Uptake Remains Low Among Medicare Cancer Patients Despite Expanded Coverage, Study Finds
Key Insights
Genomic testing uptake among Medicare beneficiaries with cancer nearly tripled from 6% in 2016 to 16.7% in 2023, yet overall utilization remains low.
NGS testing adoption was highest in lung cancer (search) patients, while breast cancer (search) patients continued to rely more on non-NGS genomic tests.
Significant disparities in testing rates were observed by age, race, ethnicity, and geography, suggesting insurance coverage alone is insufficient.
Despite Medicare's landmark decisions to expand coverage for next-generation sequencing (NGS) in 2018 and 2020, uptake of the advanced genomic testing technology among older cancer patients remains strikingly low, according to a new analysis published by Kang et al in JAMA Network Open.
The study, led by So‑Yeon Kang, PhD, MBA, MPH, Assistant Professor of Health Management and Policy at Georgetown University's School of Health, found that while overall genomic testing among Medicare beneficiaries nearly tripled from 6% in 2016 to 16.7% in 2023, the absolute rate remains far below what would be expected for a technology considered essential to precision oncology.
"Genomic testing is essential for matching cancer patients to the most effective targeted therapies," said Dr. Kang. "While genomic testing became much more common among Medicare beneficiaries between 2016 and 2023, uptake of advanced next-generation sequencing genomic testing remained relatively low, suggesting that many patients may still not be benefiting from precision medicine."
Coverage Milestones and Persistent Gaps
Medicare's expanded coverage for NGS testing for somatic mutations in 2018, followed by the addition of germline mutation coverage in 2020, represented critical milestones in broadening access to comprehensive genomic profiling. Prior to these decisions, coverage for genomic testing was limited and inconsistent, with earlier approaches often examining only one or a few genes at a time. NGS, by contrast, can analyze many cancer-related genes simultaneously in a single test, enabling physicians to identify targeted treatment options more efficiently.
Yet the new data suggest that insurance coverage alone may not be sufficient to drive widespread adoption.
Study Design and Key Findings
Using data from the Medicare Chronic Conditions Data Warehouse, the researchers examined claims from nearly 400,000 beneficiaries aged 66 years and older diagnosed with lung, breast, colorectal, prostate, or endometrial cancer (search) between 2016 and 2023. The analysis tracked the use of both NGS and non‑NGS genomic testing before and after the coverage decisions.
The largest increase in NGS uptake occurred among individuals with lung cancer (search), where NGS testing is the predominant genomic testing approach. In contrast, patients with breast cancer (search) continued to rely more heavily on non‑NGS genomic tests, reflecting differences in clinical practice and test availability.
The study also uncovered significant disparities in testing uptake. Rates varied by age, race, ethnicity, and geography, suggesting that factors beyond insurance coverage — such as provider awareness, regional resources, and patient education — may continue to influence who receives what kind of genomic testing.
"One limitation of our study is that we cannot directly compare Medicare with the overall U.S. population because our analysis included only older adults enrolled in traditional Medicare," explained Dr. Kang. "However, one finding that surprised our team was that NGS use and the growth in its uptake remained quite low across all five cancer types we studied, despite national Medicare coverage for these tests. This suggests that insurance coverage alone may not be sufficient to ensure broad adoption of precision medicine."
Implications for Precision Medicine
Dr. Kang noted that genomic testing is evolving rapidly as new targeted therapies and clinical evidence emerge. The authors recommend further research to evaluate how increased testing translates into improved outcomes and cost‑effectiveness. They also urge policymakers to consider how coverage policies can support the adoption of other emerging precision medicine technologies.
"Our next goal is to understand why genomic testing, and more specifically NGS, remains underused, and why uptake differs across cancer types and regions," concluded Dr. Kang. "We also plan to study whether receiving genomic testing ultimately leads to greater use of precision therapies and better patient outcomes."